[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2798 Introduced in Senate (IS)]







108th CONGRESS
  2d Session
                                S. 2798

  To provide for increased planning and funding for health promotion 
        programs of the Department of Health and Human Services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 14, 2004

 Mr. Lugar (for himself, Mr. Bingaman, Mr. Bunning, Mr. Campbell, Ms. 
Cantwell, Mrs. Clinton, Mr. Cochran, Mr. Graham of South Carolina, and 
 Mr. Jeffords) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To provide for increased planning and funding for health promotion 
        programs of the Department of Health and Human Services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Promotion Funding Integrated 
Research, Synthesis, and Training Act'' or the ``Health Promotion FIRST 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Lifestyle factors are responsible for almost half of 
        the premature deaths in developed nations, and a large portion 
        of the deaths in developing nations.
            (2) Lifestyle factors are a primary cause of the 6 leading 
        causes of death in the United States, including heart disease, 
        cancer, stroke, respiratory diseases, accidents, and diabetes, 
        which account for almost 75 percent of all deaths in the United 
        States.
            (3) A significant portion of the health disparities in the 
        United States are caused by lifestyle factors, which could be 
        improved by health promotion programs.
            (4) The United States is experiencing epidemics in diabetes 
        and obesity among adults and children, at the same time a 
        majority of the population is sedentary and eats an unhealthy 
        diet.
            (5) Health promotion programs have been shown to be 
        effective in improving health knowledge, attitudes, behaviors 
        and conditions, and delaying disability in older age.
            (6) Per capita medical care costs in the United States are 
        more than double those of all but 2 other countries in the 
        world, yet the United States ranks 24th in terms of disability 
        adjusted life expectancy, infant mortality, and other positive 
        lifestyle measures.
            (7) Medical care costs are second only to education in 
        State government budgets.
            (8) Lifestyle factors are responsible for at least \1/4\ of 
        employer's medical care costs in the United States.
            (9) Health promotion programs have been shown to be 
        effective in reducing medical costs and enhancing productivity.
            (10) Significant gaps exist in the basic and applied 
        research base of health promotion regarding how to best reach 
        and serve people of color, low-income people, people with 
        little formal education, children, and older adults, how to 
        create long-term health improvements, how to create supportive 
        environments, and how to address gender issues. More focused 
        research can reduce these gaps.
            (11) Significant gaps exist between the best and the 
        typical health promotion programs. Better synthesis and 
        dissemination of results can reduce these gaps.
            (12) The genomic revolution will soon allow genetic 
        information to be used to identify individual susceptibility to 
        common disorders such as heart disease, diabetes, cancer, 
        stroke, and respiratory diseases, and the most effective method 
        to prevent many of these diseases will be health promotion.
            (13) Health promotion is the most effective strategy to 
        achieve a majority of the major objectives in Healthy People 
        2010 Objectives for the United States developed by the 
        Department of Health and Human Services.
            (14) A significant increase in demand for health promotion 
        programs is expected in the next decade and a stable 
        infrastructure must be in place to ensure continual development 
        of the health promotion science base to be able to service this 
        demand effectively.
            (15) Health promotion is the art and science of motivating 
        people to enhance their lifestyles to achieve complete health, 
        not just the absence of disease. Complete health involves a 
        balance of physical, mental, and social health.
            (16) Health promotion programs focus on practices such as 
        exercising regularly, eating a nutritious diet, maintaining a 
        healthy weight, managing stress, avoiding dangerous substances 
        such as tobacco and illegal drugs, drinking alcohol in 
        moderation or not at all, driving safely, being wise consumers 
of health care, and a number of other health related practices.
            (17) The most effective health promotion programs include a 
        combination of strategies to increase awareness, facilitate 
        behavior change, and develop cultures and physical environments 
        that encourage and support healthy lifestyle practices.
            (18) Health promotion programs can be provided in family, 
        clinical, child care, school, workplace, Federal, State, and 
        community settings.

SEC. 3. HEALTH PROMOTION RESEARCH AND DISSEMINATION.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

       ``TITLE XXIX--HEALTH PROMOTION RESEARCH AND DISSEMINATION

``Subtitle A--Coordination of Programs of the Department of Health and 
                             Human Services

``SEC. 2901. PLAN FOR HEALTH PROMOTION PROGRAMS.

    ``(a) In General.--The Secretary shall develop, and periodically 
review and as appropriate revise, a plan in accordance with this 
section for activities of the Department of Health and Human Services 
relating to health promotion. The plan shall include provisions for 
coordinating all such activities of the Department, including 
activities under section 1701 to--
            ``(1) formulate national goals, and a strategy to achieve 
        such goals, with respect to health information and health 
        promotion, preventive health services, and education in the 
        appropriate use of health care;
            ``(2) analyze the necessary and available resource for 
        implementing the goals and strategy formulated pursuant to 
        paragraph (1), and recommend appropriate educational and 
        quality assurance policies for the needed manpower resources 
        identified by such analysis;
            ``(3) undertake and support necessary activities and 
        programs to--
                    ``(A) incorporate appropriate health promotion 
                concepts into our society, especially into all aspects 
                of education and health care;
                    ``(B) increase the application and use of health 
                knowledge, skills, and practices by the general 
                population in its patterns of daily living; and
                    ``(C) establish systematic processes for the 
                exploration, development, demonstration, and evaluation 
                of innovative health promotion concepts; and
            ``(4) undertake and support research and demonstration 
        programs relating to health information and health promotion, 
        preventive health services, and education in the appropriate 
        use of health care.
    ``(b) Basic and Applied Science.--The plan developed under 
subsection (a) shall contain provisions to address how to best develop 
the basic and applied science of health promotion, including--
            ``(1) a research agenda;
            ``(2) an identification of the best combination of Federal 
        agency, university, and other community resources most 
        qualified to pursue each of the components of such agenda;
            ``(3) protocols to facilitate ongoing cooperation and 
        collaboration among the Federal agencies to pursue the agenda; 
        and
            ``(4) budgetary requirements with respect to the agenda.
    ``(c) Dissemination of Information.--The plan developed under 
subsection (a) shall contain provisions to address how to best 
synthesize and disseminate health promotion research findings to 
scientists, professionals, and the public, including provisions for the 
following:
            ``(1) Protocols for ongoing monitoring of all health 
        promotion research.
            ``(2) Preparation of systematic reviews and meta-analyses.
            ``(3) Distillation of findings into practice guidelines for 
        programs offered in clinical, workplace, school, home, 
        neighborhood, municipal, and State settings.
            ``(4) Strategies to incorporate findings into college, 
        university, and continuing educational curriculum for all 
        related health professions.
            ``(5) Communication of key findings to policy makers in 
        business, government, educational and community settings who 
        influence investment decisions.
            ``(6) Identification of the optimal combination of 
        government agencies to coordinate the matters referred to in 
        paragraphs (1) through (5).
    ``(d) Support and Development of Professional and Scientific 
Community.--The plan developed under subsection (a) shall contain 
provisions to address how to best support and develop the health 
promotion professional and scientific community through enhancement of 
existing or development of new professional organizations.
    ``(e) Integration of Health Promotion; Internal Department 
Activities.--The plan developed under subsection (a) shall contain 
provisions to address how resources, policies, structures, and 
legislation within the Department of Health and Human Services can best 
be modified or developed to integrate health promotion into all health 
professions and sectors of society and make health promoting 
opportunities available to all members of the public.
    ``(f) Integration of Health Promotion External Activities.--The 
plan developed under subsection (a) shall contain provisions to address 
how overall Federal Government policies, structures, and legislation 
external to the Department of Health and Human Services can best be 
modified or developed to integrate health promotion into all health 
professions and sectors of society and to make health promoting 
opportunities available to all individuals.
    ``(g) Perspectives.--Due to 30 years of experience showing that 
traditional medical and educational approaches are not sufficient to 
motivate people to make and sustain basic health behavior changes, in 
developing the plan under subsection (a), the Secretary shall seek 
perspectives from individuals representing a diverse range of 
disciplines, including the following areas:
            ``(1) Agriculture.
            ``(2) Anthropology.
            ``(3) Child development.
            ``(4) City planning.
            ``(5) Commerce.
            ``(6) Economics.
            ``(7) Environmental planning and design.
            ``(8) Exercise physiology.
            ``(9) Financial analysis.
            ``(10) Health education.
            ``(11) Health policy.
            ``(12) Individual psychology.
            ``(13) Management.
            ``(14) Medicine.
            ``(15) Nursing.
            ``(16) Nutrition organization psychology.
            ``(17) Taxation.
            ``(18) Transportation planning.
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $6,000,000 
for fiscal year 2004, $4,000,000 for fiscal year 2005, and $3,000,000 
for each of fiscal years 2006 through 2008. Such authorization is in 
addition to other authorizations that are available for carrying out 
such purpose.

  ``Subtitle B--Basic Science Programs Through National Institutes of 
                                 Health

``SEC. 2911. BASIC SCIENCE.

    ``(a) Plan.--The Director of the National Institutes of Health 
(referred to in this subtitle as `NIH'), acting through the Office of 
Behavioral and Social Sciences Research, shall develop, and 
periodically review and as appropriate revise, a plan on how to best 
develop the basic science of health promotion through the NIH agencies. 
The plan shall be consistent with and shall elaborate upon applicable 
provisions of the Departmental plan under section 2901(a).
    ``(b) Certain Components of Plan.--The plan developed under 
subsection (a) shall include the following provisions:
            ``(1) A research agenda to develop the basic science of 
        health promotion.
            ``(2) Recommendations on funding levels for the various 
        areas of research on such agenda.
            ``(3) Recommendations on the best combination of NIH 
        agencies and non-Federal entities to carry out research under 
        the agenda.
    ``(c) Allocation of Resources.--Subject to compliance with 
appropriation Acts, the plan developed under subsection (a) shall 
provide for the allocation of resources for research under such plan 
relative to other areas of health, as appropriate taking into account 
the burden of lifestyle factors on morbidity and mortality, and the 
progress likely in advancing the science of health promotion given the 
current and evolving level of science on health promotion, and the 
relative cost of conducting research on health promotion compared to 
other areas of research.

``SEC. 2912. EARLY RESEARCH PROGRAMS.

    ``(a) Plan.--The Director of NIH, acting through the Office of 
Behavioral and Social Sciences Research, shall conduct or support early 
research programs and research training regarding health promotion.
    ``(b) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out subsection (a), there is authorized to be 
        appropriated $30,000,000 for fiscal year 2004. Such 
        authorization is in addition to other authorizations that are 
        available for carrying out such purpose.
            ``(2) Reservation.--The Secretary shall reserve not less 
        than 90 percent of the amount appropriated under paragraph (1) 
        to carry out subsection (a) through the awarding of grants, 
        cooperative agreements, or contracts to public and private 
        entities, including universities, hospitals, research 
        organizations and health promotion venders. Of the amounts so 
        reserved, the Secretary shall designate a portion of such 
        amounts to support research training under subsection (a) to 
        enhance the skills and increase the numbers of scientists 
        trained in health promotion.

  ``Subtitle C--Applied Research Programs Through Centers for Disease 
                         Control and Prevention

``SEC. 2921. RESEARCH AGENDA.

    ``The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention (referred to in this subtitle as the 
`Director of CDC'), shall develop, and periodically review and as 
appropriate revise, a plan that establishes for such Centers a research 
agenda regarding health promotion. The plan shall be consistent with 
and shall elaborate upon applicable provisions of the Departmental plan 
developed under section 2901(a).

``SEC. 2922. HEALTH PROMOTION RESEARCH CENTERS.

    ``(a) Authorization.--The Director of the National Center for 
Chronic Disease Prevention and Health Promotion (referred to in this 
section as the `Director') shall award grants, on a competitive basis, 
to eligible entities to enable such entities to develop Health 
Promotion Research Centers (referred to in this section as `Centers').
    ``(b) Eligible Entity.--In this section, the term `eligible entity' 
includes--
            ``(1) institutions of higher education;
            ``(2) public and private research institutions;
            ``(3) departments or schools of--
                    ``(A) business;
                    ``(B) city planning;
                    ``(C) education;
                    ``(D) nursing;
                    ``(E) psychology;
                    ``(F) public policy;
                    ``(G) transportation; and
                    ``(H) social work; and
            ``(4) private research, membership, or service 
        organizations.
    ``(c) Application.--An eligible entity that desires to receive a 
grant under this section shall submit an application to the Director at 
such time, in such manner, and containing such information as the 
Director may require. An eligible entity may apply for not more than 3 
grants each with a duration of 5-years.
    ``(d) Awarding of Grants.--
            ``(1) Number of centers.--The Director shall award grants 
        for the development of not more than--
                    ``(A) 5 new Centers in fiscal year 2005;
                    ``(B) 5 new Centers in fiscal year 2006;
                    ``(C) 5 new Centers in fiscal year 2007;
                    ``(D) 5 new Centers in fiscal year 2008;
                    ``(E) 5 new Centers in fiscal year 2009; and
                    ``(F) 5 new Centers in fiscal year 2010.
            ``(2) Grant period and award amount.--Grants awarded under 
        this section shall be for a period of 5 years. A grant award 
        shall be in an amount not to exceed--
                    ``(A) $500,000 in the first year of the grant 
                award;
                    ``(B) $1,000,000 in the second year of the grant 
                award; and
                    ``(C) $2,000,000 in each of the third, fourth, and 
                fifth years of the grant award.
            ``(3) Focus of centers.--In awarding grants under this 
        section, the Director shall ensure that--
                    ``(A) not less than 1 Center concentrates the 
                Center's efforts on developing the applied science of 
                health promotion in each of the following areas:
                            ``(i) the workplace;
                            ``(ii) schools;
                            ``(iii) families;
                            ``(iv) clinical settings; and
                            ``(v) community settings; and
                    ``(B) not less than 1 other Center focuses the 
                Center's work on each of the following areas:
                            ``(i) program evaluation;
                            ``(ii) training and support of the health 
                        promotion professional workforce; and
                            ``(iii) health promotion policy at the 
                        Federal, State, and local level.
    ``(e) Uses of Funds.--
            ``(1) In general.--
                    ``(A) Provision of advice and organization.--A 
                Center that is developed from funds from a grant 
                awarded under this section shall invest approximately 
                10 percent of the Center's staff time and resources 
                to--
                            ``(i) forming relationships with, and 
                        providing limited ongoing advice to, health 
                        departments in the county and State where the 
                        entity is located; and
                            ``(ii) organizing local networks of 
                        scientists, program managers, vendors, and 
                        other professionals interested in health 
                        promotion and disease prevention.
                    ``(B) Use of outside providers.--When conducting 
                intervention research or research on other health 
                promotion programs, a Center that is developed from 
                funds from a grant awarded under this section shall 
                review the capabilities of local nonprofit and for-
                profit program providers to provide the programming and 
                services required for the programs. The Center shall 
                use such program providers if the program providers 
                provide a clear quality and cost advantage relative to 
                developing such capabilities internally.
                    ``(C) Addressing priorities and research agenda.--A 
                Center that is developed from funds from a grant 
                awarded under this section shall address the priorities 
                identified in the health promotion research agendas 
                developed by the Centers for Disease Control and 
                Prevention, the National Science Foundation, and the 
                Department of Health and Human Services.
            ``(2) Permissive uses.--An eligible entity that receives a 
        grant under this section may use the grant funds for faculty 
        salaries, student fellowships, outreach to the local community, 
        research, program development, or program administration.
            ``(3) Administrative costs.--An eligible entity that 
        receives a grant under this section may expend not more than 15 
        percent of the grant funds on administrative costs.

``SEC. 2923. EXTRAMURAL RESEARCH PROGRAM.

    ``(a) Outreach.--In carrying out the Extramural Research Program of 
the Centers for Disease Control and Prevention, the Director of CDC 
shall make an effort to attract grant applications from groups with 
extensive experience in providing programs but limited experience in 
developing research grants or conducting research, or both. Such 
efforts shall include proactive outreach to such groups, providing 
planning grants to fund development of grant proposals, and providing 
technical assistance for the design portion of the grant application.
    ``(b) Applied Science of Health Promotion.--In carrying out the 
Extramural Research Program of the Centers for Disease Control and 
Prevention, the Director of CDC shall devote a portion of research 
funding to developing the applied science of health promotion for 
workplace, school, family, clinical, and community settings.

``SEC. 2924. WORKPLACE HEALTH PROGRAM.

    ``(a) In General.--The Director of CDC shall carry out a program--
            ``(1) to develop a research agenda for workplace health 
        promotion and shall seek perspectives from a wide range of 
        workplace health promotion program practitioners and scientists 
        in developing such agenda;
            ``(2) of research that addresses the important issues 
        identified in the research agenda under paragraph (1); and
            ``(3) to support synthesis of findings made in such 
        research and to disseminate information to educators, 
        practitioners, business leaders, and health policy leaders.
    ``(b) Authorization of Appropriations.--For the purpose of carrying 
out subsection (a), there are authorized to be appropriated $6,000,000 
for fiscal year 2004, $8,000,000 for fiscal year 2005, $11,000,000 for 
fiscal year 2006, $15,000,000 for fiscal year 2007, and $20,000,000 for 
fiscal year 2008.

``SEC. 2925. CERTAIN REQUIREMENTS.

    ``(a) General Goal of Programs.--The Director of CDC shall ensure 
that programs carried out pursuant to this subtitle are consistent with 
the general goal of developing the most effective individual and group 
strategies for clinical, workplace, school, and community based 
programs regarding health promotion.
    ``(b) Reservation for Award to Public and Private Entities.--
            ``(1) In general.--Of the amounts made available under this 
        subtitle, the Director of CDC shall reserve not less than 75 
        percent for the awarding of grants, cooperative agreements, or 
        contracts to public and private entities, including 
        universities, hospitals, research organizations, and local and 
        national health promotion venders through collaborative 
        efforts.
            ``(2) Requirement for state and local health departments.--
        Awards made to State and local health departments pursuant to 
        this title shall be made on the condition that the departments 
        develop a basic staff infrastructure to manage the programs for 
        which the awards are made. With respect to such condition, the 
        departments may contract with providers in the communities 
        involved to secure programs and skills required to carry out 
        the programs.

               ``Subtitle D--Other Programs and Policies

``SEC. 2931. MODIFICATION OF APPLICATIONS AWARD PROCESS TO ATTRACT MOST 
              QUALIFIED SCIENTISTS AND PRACTITIONERS; DEVELOPING HEALTH 
              PROMOTION INFRASTRUCTURE.

    ``(a) Modification of Awards Application Process.--In awarding 
grants, cooperative agreements, and contracts under this title, the 
Secretary shall modify the application process to attract the most 
qualified individuals and organizations, rather than those individuals 
and organizations that are most sophisticated with respect to the 
applications processes.
    ``(b) General Priority of Developing Health Promotion 
Infrastructure.--The Secretary shall ensure that programs carried out 
pursuant to this title are consistent with the general priority of 
developing the health promotion infrastructure among universities, 
nonprofit organizations, and for-profit organizations, rather than 
increasing the size of State or local governments or the Federal 
Government.''.
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